This is Keith Horton being interviewed by Derek Hockaday, 19th of September, 2004.
Keith, I saw that you were Cambridge based originator.
What made you choose Cambridge rather than Oxford? Happenstance or or definite choice?
Oh, it was so many things that in those days in the 60s were sort of depended on serendipity.
It was simply that a friend of mine at school had applied to Cambridge and I hadn't thought of it.
And we weren't particularly Oxbridge feeding school.
And I thought, well, I've got better and levels in him.
So I just wrote off to Oxford and Cambridge colleges and or groups of colleges, as one did then.
And St. John's accepted me without an interview at St John's Cambridge.
Great. So, I mean, the choice was clearly that it wasn't a question of selecting me, selecting a particular place to go to.
In fact, six of us from the school went to Cambridge that year.
So it was a relatively you have you got any views on the preclinical training, Oxford, the Cambridge at that time?
Well, I mean, I I'm a peculiar beast in this respect, in that I didn't come didn't go into medicine immediately.
I started off doing reading natural sciences, um, and the physiology, of course, with the medicks in those days as part of natural sciences.
But I ended up specialising in it in psychology.
So I did have subjects, experimental psychology, and I ended up doing part to experimental psychology.
And then I was all set to go to I can't remember why now, but wisconson to do a Ph.D. in psychology.
And um, and then we had some lectures from some very charismatic psychiatrists from Forsworn Hospital in Cambridge as part of experimental psychology.
And I just was captivated by this. And it was all around the days of running Lang and, you know, all these sixties thinking.
And it just appealed to me that this this really could be an interesting route to go.
So I went to my college tutor who was a psychologist at Wellford and said to him, I've decided I want to be a psychiatrist.
And he looked at me for a while saying anything and then said, well, you'll have to do medicine, isn't it?
I had no idea. You didn't I mean, know, it was so naive in those days we were there.
And so then he said, well, you have to have it next year in Cambridge to do anatomy qualifying and one or two other things,
which are less outside labs nowadays in Cambridge. And that's how I came in.
So I didn't really have a sense of the preclinical school in Cambridge in those days because I wasn't, you know, in a sense, even part of it.
Experimental psychology was very distinguished.
It was French and there were medicks who were, you know, doing their first two years and then a third year in that.
Yes, John Oxford did. Yes. And my year was Colin Blakemore Ruddock, who then became head of the commission on John Teesdale,
who was ended up working here, very distinguished, uh, clinical psychologist.
And so it was tremendous and really inspiring.
And actually, I felt equipped me very well to Tickie from my later career when I got into research because it was so experimentally based,
whereas of course, with a lot of the clinical medicine was not much more feeding it with facts and gender.
Yeah. And so on to then Oxford were looking for Cambridge people at the time.
I mean, did you have difficulty getting into the Oxford Clinical School?
No, I didn't. Well I did. I was accepted so I said, well I tried remarkably.
There are only three of us from Cambridge. Our intake in those days, of course, it was when we had the split six months intake, Oxford,
Cambridge and the mind maintains eleven million students, three of us, I think three of us from Cambridge.
So it didn't I didn't seem to have difficulty from.
And how your clinical student goes, I love them, I mean,
I thought we were incredibly lucky in the sense of but I guess some people say, well, it was far too small there.
I think there were 63 students in the medical school, the political school, when I arrived.
But because of that, I think we had extremely good relationships with, you know, um, teachers and and so on.
And somehow we managed to mount a fantastic rugby team with that small number, although it was supplemented by various people on the staff.
And the medical school was just a happy place. And I felt I was so lucky to be in Oxford.
And of course, the buildings in those days were the medical school buildings were lovely, you know, which is what is now green in college.
And so I, I, I find it a very great time.
And you never wavered in your wish to be a psychiatrist? No, I didn't.
I mean, I was considered a very odd fish because psychiatry hopefully less so these days,
but in those days was regarded as a somewhat odd speciality, attracting old people.
And yet here was someone who was playing rugby, cricket, various other sports.
And one of the lads still wants to be a psychiatrist.
So people couldn't quite fit it.
But I didn't I didn't waiver at all.
And how did you what did you think of your Time Warner and the other place as a student doing the psychiatrist bertelmann about?
Well, yes, we we didn't spend a bit of time with Bertie Mandelbrot.
It was I mean, it was all very odd over a little more.
I mean, they were running community therapy, which to me seemed bedlam.
And I mean, they when really we came to the one foot and had a month here that, you know, I think we got much more systematic teaching and so on.
And it came across people who I sort of had more respect for in the sense of their approach to psychiatry,
which fits in more with, you know, where I come from in experimental psychology and and so on.
So did you and you have a month of psychiatry in those days?
I'm pretty sure we only had a month. Yeah. And you had a GP attachment?
I did. Did you enjoy that? I did. And I did it out of Atterberry.
And I did this every time I drive through. And I remember that fondly.
And, you know, it's good. And knowing you were going to do psychiatry.
So how seriously did you take the medicine and surgery and is, you know, whatever?
Well, I wouldn't have said I was the most dedicated student.
I have to say surgery did not attract me at all.
And so I think I probably did the minimum to get by with surgery.
Of course, I have to do a surgical house job, and I do Pennypacker, you know,
the neurologist was here then and he helpfully arranged me to do a neurosurgical house job so I could get,
you know, I could bring him in the direct entry to the brain.
Yeah, I was Scandrick. So I went to Manchester and did a house job in neurosurgery, which was extremely Jefferson.
No, no, don't worry.
I've forgotten the name. Dustin was one of the consultants and the other chaps name of them.
I know Jefferson had left, but that was.
But there was Ted Buckley was there. Yes. Who said he was the senior registrar.
So that was. And was that before or after your job?
That was my it was after I had my house job, first house job with Leo Warner down at the county road and with cousins below.
And he met him once and he was in America.
I think he's somewhere else. Yes. But you didn't get attracted to the secretary of old age psycho geriatrics, which is a special dinner?
No, no. I didn't know that side of psychiatry didn't track me, knows I was more interested in adults,
young adults, particularly the sort of neurotic end of the spectrum of psychiatry.
Although, you know, I embrace the broader severe mental illness, schizophrenia and so on,
aspects of the enjoy that, but I wasn't attracted really to psychiatric drugs.
So then when you're done, your house shows what happened then. Then?
Well, I was up in Manchester at that stage doing the neurosurgical job and I really wanted to come back to Oxford.
I loved Oxford and I'd been here ever since more or less.
So I applied for it was a locum job, came up with Seymour Spencer.
And so I applied for that. And I came in September and there was plans being made them for a proper training scheme in psychiatry.
And I was lucky enough to be one of the first trainees on that scheme.
So it was a proper three year. So this is about two.
Oh, gosh. Um, because you're qualified, you know, so much earlier, much earlier at 69 or so, I got my dad.
So that's 70. So this would have been 71. Yeah, simply 132.
Yeah. So I came to with Seymour Spencer and then I got on the training scheme and and had they funded the chair by then.
Yes. Michael. And was already here. He came in 1968. So he was already here.
And there was, you know, the exciting things going on with the new department.
And what was for me was very special was I got involved with research more or away and got involved the project with David Juliar,
John Bancroft and the gaffer's involved in looking at psychiatry in the general hospital.
So it was it was it was screening medical patients down at the old, you know,
where I am for psychiatric disorder and actually ended up with a seminal research paper in the BMJ.
It was the first one of its kind when the country was beginning.
And Richard Matt was very keen on that thread. Yeah. And I always wonder the bit.
I mean, here these guys, they're real.
There's not surprising if they're a bit of centre and how the what is the relationship between that and what they're like when they're better,
they get better? Well, I mean, I think the erm obviously the relationship between physical illness and mental illness or mental problem,
psychological, psychiatric and psychological problems is complex. You know, it's it's two way.
There's other factors that can play, such as, you know, the treatments for physical illness, of course,
can have some can have psychological psychiatric effects, as can the effects of psychiatric drugs.
I think one of the important things we discovered, which we didn't know then,
was that having a psychiatric disorder, we don't usually talk about depression here.
Anxiety has been more pronounced, seems to have an influence on the prognosis of the physical disorder.
And it's been shown very,
very clearly for cardiac people who had cardiac erm phones and those who had depression have a far greater mortality subsequently.
So there's there's an important relationship there.
And in some patients, when their physical illness improves, the psychiatric problems will often they won't.
And of course you have to look back at vulnerability factors as family history and so on and so forth.
And these all come to play on in terms of the prognosis of those.
So this is the opposite of the placebo effect.
Yes, I suppose you could say, because always feel that the placebo effect is getting the patient's autonomic system in an ideal condition.
And of course, we can't measure the ordinary knowing.
Great, you know, it's just a dream that we've been lovely in these patients to be able to measure that somehow.
Yes. Yes. I mean, we really still don't know how placebos work.
And yet, you know, we know for sure drug trials that, for example, in my field, in antidepressant treatment of depression,
you get about 30 percent response with the seaburg and the doctors, the placebo group and the doctor.
Of course, the way it's delivered this patient is really important.
So when did you, as it were, or maybe you didn't, did you withdraw from clinical work to write a thesis work on and.
No, I didn't. M.D., um. And was able to do the my research in parallel with my clinical work.
By that time I'd become a lecturer and in the department here.
And so I was and Michael Gallagher was very protective.
I mean, lots and lots and lots of, you know, skills.
And one was that he ensured that his unlike in many other departments,
that is an academic staff really did have time to do proper research and that the clinical work was very circumscribed.
So that was very helpful. So I was able to do an M.D. in parallel with Michael Girdler, in a sense, had a blank sheet right on.
But of course, he was actually demoted and he is really the guy who built this place up.
Is that correct? Absolutely.
And I mean, as you know, Michael, incredibly high standards, which at times, of course, put pressure on trainees and and so on.
But I mean, the standards, he said, I think were most things were fantastic.
And he had very close, very high standards in research.
And yes, absolutely one of the reasons for the success of this department as being those high standards,
he said, but also the fact that he integrated biological and more psychological,
even psychosocial aspects of psychiatry,
he was able to embrace those within the department or some other departments can't have gone down the biological route or less.
So the more psychological route, the great success here was that he was able to, you know,
bridge across those that always been the tradition because Jeffrey Harris worked with Robert.
And then I think the unit came here. Did it? That's right.
They had a unit a little more for a while. And and then it then it moved here.
And now we have a full year in neurosciences unit with three or four classes because early days, David Graham Smith sort of took over that aspect.
That's right. And did you see him or. I didn't know? Well, I wasn't really involved much with that side.
Some of my colleagues went and trained with him because I think it was mainly based on the practise, but they were doing psychopharmacology research.
And I think people like Phil Cowan, who's here now, and others, they trained with him.
And so we felt the influence of that in the department. Yeah.
So what was your M.D. on my India on self-harm or attempted suicide?
How you got onto that by then? I got onto that by then, yes.
My boss, one of my bosses during my psychiatry training was John Bancroft.
And he this was during the times when the General Hospital was just beginning to
experience increasing numbers of patients coming in with overdoses and self injuries.
I mean, I think the rates in Oxford quadrupled over ten years.
And Michael Gowda said to John Bancroft is his reader.
Would you go and try and find out what's going on? Because we couldn't.
You can't you couldn't provide a decent service for these people going in after hours and trying to see patients and they'd left and so on.
And so he wisely set up a research programme and said, well, let's find out more about it,
which, you know, is always a good way of going about things.
And then a clinical service developed out of that work.
The Bones unit developed out of that the on psychiatry service.
And he got Department of Health Research funding and said to me, would you like to come and do some work in this area?
And I thought, well, probably have a short life, last life working in suicide research, but I would do it for a couple of years.
And so I worked on the balance in the West that I had developed that that because that was very useful.
Then Dennis Scarce was there. He was a great guy. Yes. Yes.
Dennis was. What was he working on? Well, he did a range of things, but he got he got involved in general hospital liaison psychiatry.
Again, he worked a lot on women's problems, problems related to depression.
Um, psychological. Psychiatric.
Various gynaecological problems, as Richard may have worked on, road traffic accidents work on the psychological impacts of road traffic accidents,
but they were sort of, you know, working quite closely, closely together.
And of course, Dennis was a great mentor in turn.
I mean, he he he got an English degree or languages before he made the and so he was a great writer.
And he was one of the reasons really for the success of the Oxford textbook. This country beautifully written.
But I have to say, he was a tough act to write with because when I went through so many draughts,
I think when people went through the 30 draughts, but it was all about the common cause of death and so on.
Now, when did the first edition of that come out, roughly, would you say?
Because, um. Oh, gosh, I you know, I think I well, I thought it was during the 80s and I said yes, because Michael Geldof has been involved in that.
Oh, yes. Yeah, it was it was Michael Dennis. And I think Richard maybe to a lesser extent on the stage, but, you know,
no Michael, go to war and always heard he was really keen on punctuality is said.
But otherwise I would imagine he was a and even when annoyed or not.
Yes. I think there were times when he annoyed.
I mean, he did have you know, he was a stickler for timekeeping.
He just couldn't stand sloppy thinking.
And he comes from the Maudsley where, you know, the training there had been so rigorous.
And his approach to patient assessment was I mean, I had to say, I mean, it's far better than one of the nurses now being practised.
And, you know, for example, if you hadn't spoken to the relatives and got a full family history, you know, you hadn't done your job.
I mean, even if you lived in the suburbs.
So he, you know, and it was it was great.
And people think, you know, now refer back to those standards and say, gosh, you know, that's what we should really aspire to.
Oh, that's a great I mean. Yeah, yeah. So now your thesis, would you have taken that?
We wouldn't have had a word processor and. No, no. I mean, that's the I mean, it's unbelievable now isn't it.
I mean, I had a secretary I didn't know I had a secretary who typed you wrote it in and then of course it went through many draughts,
several draughts, including tables, and they all had to be retired.
I mean, it's just extraordinary. And, you know, when I tell junior researchers now, I just can't get at them.
And who examined you? Um, um, I was examined by a professor in Bristol Gethard.
Morgan, right. Yeah. I never actually had a face to face.
Vivir know it was dumb. Oh that's very good. Well hi.
And did you, I mean did you see the comments. Um well I think it was just a general positive comment.
You they have to write something. That's all I've got for you. So. Yes.
Yeah great. And I mean, did you in any way change direction after that or did you when did you become a consultant?
What? Well, I spent a long while in the academic department.
I think I joined the department in nineteen seventy four and I was a lecturer and then clinical tutor,
which here is the person who organises people's student training.
Very good. So I did like 12 years in that, you know, I had two lecturers jobs, then became a technical tutor.
And so effectively I was at the level of senior registrar for around twelve years, which is now extraordinary.
You couldn't do it now. But for me it was wonderful because I, I developed a full you know, what was quite a research programme.
I was doing clinical work, so I was acting as a consultant, running an inpatient unit, an outpatient and outpatient a week.
Oh, well, once I when I got to be a consultant, which is 84, we were dealing with a population of something like 200.
5000, so we had a chunk of the city, I think, of the city, I think a third and west, so she'll be here in those days.
So I like I know how many outpatients a week, multiple sessions, sessions.
Oh, I see. Um, I think it was two or three, but we had a very big inpatient unit, so we had 25,
although it went down to 23 inpatient beds and I was the sole consultant. But I had I did have a really good most of the time junior medical team.
And Michael, because I was a, you know, university senior lectureship,
then ensured that I had plenty of senior registrar times and lecturers would come and work with us in addition to the NHS senior registrar.
So we had a big medical team. And and by that sort of towards the end of your time as a clinical tutor,
how long did the medical students come to you for whether they were then coming for eight weeks?
Yeah, I guess. Yeah. Yeah. One of the things Michael did say earlier when I first arrived in the department,
we used to have weekly departmental meetings just as the, you know, team sort of in the department, which is quite small.
And most of those were focussed on how to improve teaching for students.
And I think it's fair to say that the as a result of that, the second I think the teaching the students got, I think was a very high standard.
And I think I you know, it was a sort of parallel with what they got an orthopaedic surgeon who was very well organised.
And we had a day, for example, a day formal teaching per week.
Um, and and they still do this.
And so that tradition has continued.
And I think I'm not you know, and we've had to battle, of course, against prejudice, against psychiatry and and so on and so forth.
And I think we do have to make special efforts to teach and, you know, to counter some of the negative attitudes some of the students come with.
And I think most of them really enjoy it. And the impression I got then your relationships with the university, I mean,
both the clinical students and everybody else, because they always used to be said that the world would go first.
And baby, I mean, what I did, I go on. I don't know.
No, I think the I mean, at one time this was the the student, you know, university members,
whether they be a students or staff, would come to and we had a very different psychiatric service then.
So they would come to the ward further. It was a little more tender to deal with, you know, the sort of general more with the general population.
When we all became when it became sex, control became secularised. In other words, consultants dealt with particular areas and particular GP groups.
And that all changed, although there was still a tendency for university staff to come here.
No, I mean, we had a psychologist here, Mae Davidson, who was there, and she'd worked with several burns and,
you know, in the ward and things on the fly, fighter pilots and so on.
But she she took a lot of students under her wing.
And that was part of the reason that so many, you know, actually took their exams here.
Um, and, yes, I think we had more firsts.
I think we were top of the unofficially.
And do you think the phenomenon of undergraduate suicide death was a push towards Oxford concentrating on suicide,
or was it more that and you said all thanks,
but no, I think it was more what at that time was what was happening with regard to attempted suicide or self-harm.
That was the driving force. So it was it was in a sense driven by clinical pressures and needs.
But there was, of course, the problem of student suicides and undoubtedly Oxbridge had,
you know, reading the research papers in the 40s, 50s, some extent.
The 60s did have very elevated rates of suicide compared with young people in general population forty.
That's no longer true. Right. And we've done a lot of work on that since the mid seventies.
And, you know, student deaths, of course,
the tragedy is that it looks pretty clear that the rates aren't higher at Oxford and Cambridge than in the general population.
I'm not sure about other universes that not many of us collect very good data, which is extraordinary, really.
Any idea why that was going on in the 50s? Well, I think there were a number of factors.
I mean, I think the gender ratio didn't help. I mean, the huge excess of males, I think it probably had to do with the post-war,
you know, the gender or the war generation and people not talking about problems.
Not a lot of young males still have difficulties were not as bad as then, I think attitudes towards mental illness and the availability of gas.
And, of course, we had gas fires. I mean, one of the things we've learnt in suicide research is that the availability of method,
dangerous methods, is crucial to influencing suicide rates.
And that's your campaign against paracetamol? Well, it was about, you know, smaller packs of paracetamol and particularly the work we did on proximal,
which led to its withdrawal because we discovered that one in five fatal overdoses involved that one drug.
And, you know, it was work we did that stimulated the regulatory agency, the MHRA, to investigate it and then withdraw it.
And, you know, I guess for me, that's one of the most rewarding things I've been involved in.
I had to present the research to the research findings to the European Medicines Agency,
and that led to an EU ban throughout the EU and the states and territories and the states of.
Yeah, but they, of course, found another reason for doing so. I think cardio cardiac toxicity was a suicide and suicide.
Obviously, either group can make a mistake, you know, get the wrong group.
But do you fundamentally regard them as different phenomena or are they going to regard them as very overlapping?
Yes, and for for various reasons. One of them just sort of touched on in the sense, you know, what method happens to be in the general public.
You know, safety comes to taking overdoses of tablets are very, very ignorant.
That's not the right term. But I just don't know. I'm aware of time.
As I always remember, someone, an elderly woman presenting was taking six penicillin capsules and she was highly suicidal.
And she said, well, I've been told that one kills millions of bacteria. You may you know, it was really quite impressive.
So it's you know, it is often a chance.
The other thing we know is that the suicidal ideas are often very fleeting.
I mean, bizarrely, people have interviewed people who died after jumping off the Golden Gate,
I'm sorry, or jumping off the Golden Gate Bridge another.
And I'd done it with interviewing someone in the states who can put another bridge in Boston.
And they these people, what they say is once they done jumps,
they talk about the ambivalence of doing it and then once they jump their first thought of survival.
And, you know, that really is a telling message.
So the whole thing is, you know, has a lot of ambivalence to suicidal ideas often, you know, very brief.
OK, there are some people who are absolutely determined to die and and so on and so forth.
But I think, you know, there is a big overlap. So I see it as a spectrum sort of spectrum.
You know, now the people that, you know, generalisations were giving barbiturates to those people,
how much backwash did you get up here with addictions and.
Oh, not so much with addiction. So there was some psyche with the I mean, the barbiturates were sort of being phased out really early in my career.
So I wasn't so aware of that.
But certainly with minor tranquillisers and those were the main drugs used for overdose at that time because it's no longer true.
And we were certainly seeing people who were dependent.
Um, but then the message went out to primary care.
I always remember a paper in the BMJ don't prescribe pills for personal problems, and it was all about tranquilise.
And this country got the message and the prescribing went right down.
And there's research showing clearly how. Impacted on well, obviously on addictions, but the overdose rate of those drugs went right,
went right down, whereas in other countries that hasn't happened in Ireland, for example, they still have.
And that's true is that the GP's have a Renai because you often hear about they have no idea.
Tranquilise, I really got the message on that. So what do they give people?
Um, well, they admit that if they give tranquilise them and give them for no longer than two weeks, they're pretty strict about it.
Or hypnotics, obviously something you need long term treatment and they talk to them or.
Sure. So how much time did you spend abroad?
America times in America.
Where were strictly visits? I mean, I think over on a a month trip, mainly for the teaching of medical students.
But I spent I spent four months in the Netherlands.
I had a visiting professorship at Leiden University, which is a wonderful place.
I really enjoyed that. It was really important as a break. Alex Gatherer was the in charge of consultants in those days.
And I always remember going, lovely man. I remember going to him and saying, I've got this invitation.
And, you know, there were complications about how much income, how much they were going to give me and quite match up to my salary here and there.
And I always remember saying, Keith, let's start from the principle we're working on.
You're going. Yes. And it was fantastic. Yes.
You know, whereas I don't know I don't think consultants I mean, because I was then an NHS consultant work.
But, you know, with running Renninger being able to run the research programme, I didn't have the consultants these days get that sort of it.
And then I spent time in New Zealand visiting position there.
But yeah, but there is a link to suicide or separate.
Um, well, that the New Zealand one was in the sense I was mainly giving lectures around suicide.
The one in Leiden was more general and I was doing a lot of teaching of trainees there,
which was interesting because I couldn't speak the language, but they all speak. Yeah, in English.
But when it came to interviewing patients, I'd have to have a one way screen and I have somebody with me translating.
Somebody else would interview the patients and somebody else would translate. So it was an interesting way of teaching.
But no, it was more general psychiatry and I was doing work then still in general liaison psychiatry.
So we were doing a lot of work on chronic fatigue syndrome at that time.
I think we did some of the original work on that condition here and in the first round, the first psychological therapy trial on that.
And what was your sort of outcome as to its pathogenesis?
OK, well, I you know, we took the view. I mean, of course, as you know, there's tremendous controversy and it goes on about what caused it.
I mean, we took a sort of rather pragmatic approach, which was here's a condition which is disabling.
We don't really understand what factors cause it, uh, it may be due to, you know, a range of of of factors.
But one thing is important is the psychological reaction to whatever's going on that seems to make things worse.
And I mean, that seemed quite clear. And therefore, we adopted a rehabilitation model.
Um, namely, what can one do with psychological therapy to try and help get getting people going,
getting them to change their attitudes, to live with it in a sense. And, uh, um, and rehabilitate.
And of course, I mean, that attracted enormous objection from people who believe in me.
You know, the other term, chronic fatigue syndrome. I was a benign myalgic encephalomyelitis and the hate campaign.
We experienced some of it against people who have been trying to help people with the psychology is unbelievable.
Absolutely unbelievable.
I mean, Simon Wesley, who's suicidal, Wesley, now now present the Royal College psychiatrist who was doing similar work in Kings.
I mean, he had he had death threats. I mean,
and to the extent that he'd go to conferences in the States and people wouldn't want to go out to dinner with him because they thought he might be.
It might be a risk. I mean, he's had to move out of the area, the streets were against it,
against the like, and it wasn't states, it was the it was this these people which are,
you know, this country, USA, who believe it's due to mercury poisoning and all, you know, all sorts of things.
And you just cannot accept that the notion.
Well, OK, but let's try and help people using a psychological approach,
because the implication they have is you're saying this is all in the mind, it's a mental disorder.
I'm not saying that. You know, it's. Yeah. So how much time did you have to spend, say, going up to London to national bodies, international bodies?
Um, quite a lot. And I still do. I mean, I got a lot on the National Suicide Prevention Advisory Group.
I've been on that right since the beginning when we first developed the suicide
prevention strategies during the Department of Health or the Department of Health.
I've been on temporary Department of Health working groups on evidence based psychological therapies and a number of other things.
I sit on the police Ekpo, the Association of Police Officers, now have a national suicide prevention strategy group.
Um, and then I suppose a lot of the ad hoc meetings, um, one last week,
Chief Medical Officer launching their annual report, which had written a Chapter four and so on.
So yeah, I know. And when you went European with Proxima, did any of your liden friends help in that?
So was that quite similar? No, that was separate. No, they weren't, um, they they weren't involved with.
Did you get a Dutchman over here? Um, well, we had some visits.
Interestingly, I'm just in the middle of arranging a clinical student from Leiden to come and work with us for, I think two or three months.
Yeah, I and and he's got to do some research with us.
So, I mean, it's good that that links continued. Um, so you were saying you've written a chapter of this national report.
How much writing do you do? I mean, I spend my life writing, editing and writing books.
And I mean, I did I used to have always had one or two books on the go.
But I must say, I find them more of a struggle these days and haven't actually when I've got one in mind.
But what sort of what I won on the psychology of suicide, which I would be really interested to bring in all the sort of psych,
you know, the psychological components of suicidal behaviour and the psychological models.
But whether I would do it or not, I'm not sure. And I we've got one on the shelf on media influences on suicide, which I'm afraid is half done.
And it's been half done for rather a long while. But, um, that is so if somebody commits suicide, they'll say, well, I mean, we did it.
We did a study back in ninety six, seven, I think it was looking at a casualty programme where the a paracetamol overdose.
And that was in the days when Casualty had viewing figures or what.
That particular one. We investigated our viewing figures. Twelve million.
I mean it's unbelievable now that one programme that this chap took a paracetamol overdose, the implications were going to die.
He's going to die. He had a haematoma. It's not very pleasant.
And you think would put people off. And we were able we had such advanced warning,
we were able to get a grant to do research on this because they weren't going to change the schedule, change the script.
The script. Right. Did change a little bit with some advice from us.
But and we got data from 43 hospitals and interviews with patients in 23 of those animals.
And we are much to our surprise, we found that there was a very significant increase in paracetamol overdoses.
I mean, it was in those who said they watched the programme and I've seen those who said they hadn't watched the programme.
Um, and when asked specifically how it influenced you, I a very sound proportion said yes to that.
And they chose the paracetamol because this and the impact lasted about two to three weeks is actually extraordinary.
And and it's always cited now as a, you know, one of the.
In a key piece of evidence in relation to TV programmes that they.
Yes, I mean, you know, it has a perfect can have a profound effect.
And then there was the famous room that when the doctors withdrew their services, the suicides went down.
That's right. Well, there wasn't very good data on.
Right. I think it was some London data suggesting that fewer people are presented and and so on.
I mean, I honestly, I didn't think the data were very good.
Okay. But, you know, it's interesting because, I mean, it raises the question, you know,
when a person takes an overdose in the heat of an argument or something relationship or do they think about ending up in hospital knows the answer.
So I'd be surprised if those data were accurate. Any of the hospitals.
The last thing you're thinking of right now, if you look, it's difficult, but take the young man qualifying today and back in your time.
How much is the sort of psychiatric awareness change, would you say?
Well, I think it's improved. I mean, one of the problems is and I'm referring to what happens in Oxford at one time,
we had a lot of teaching on the medical wards and we used to, you know, for example, to interview training.
I mean, Tony, Hope is very involved with this is do interview training of students, which had a sort of emphasis on the psychological side.
We had more much more teaching going on through the eyes on psychiatry.
We used to run a few sessions a week with medical students when they're on medical terms, thinking about psychiatric aspect.
Unfortunately, that's no longer happening. So. Well, stop there.
What I don't know. I think it's just that, you know, the the pressure on the timetable has been, you know, probably the main issue.
Um, I mean, I used to run a teaching day here on two days on sexual problems,
getting clinical students to think about that aspect of people's problems and the impact of physical illness.
And that no longer happens. So I don't know where they get training on that.
But, of course, patients are going to present in primary care and so on with these problems.
I mean, you know, whether they discuss them with the doctor or not. Yeah. And on with the underlying, you know, I mean.
Exactly. So I would say things have improved in some ways and not in others.
I think the stigma around mental illness is slowly shifting, but it's very much two steps forward and one step back.
And I think some might near the recent death of Robin Williams makes people more aware of the impact of mental illness.
But that can rapidly get countered by some newspaper headlines about, you know, that person goes on the rampage.
And so and that I think, you know, students are affected by these things.
But I think I think it all I think the crucial thing is what's happening in the general hospital,
to what extent students see mental clinic psychiatric practise as being part of medical practise.
I mean, I was talking to one of my clinical students the other day said, look after some students.
College through which college? Greentown. Yeah, yeah.
And he was saying it's fascinating. He said this is so different.
You know, it was just it is I mean, it's very different.
I mean, fortunately, he said some very positive things about how he's been looked after in psychiatry and,
you know, welcoming people are and the opportunity you got.
But you clearly see it in a very different and we're a long way from having that sort of integration.
And I people are talking these days about how you come across this parity of esteem is the N word,
which is which is about parity of resources and so on for mental health services.
As for physical health services. And we're a long way from that. Yeah, yeah.
And I think, you know, that the integration seeing things is more integrated is sort of crucial.
But I think, you know, for example, I mean, I think in psychiatry, people,
you know, I think there's not enough emphasis on the physical health of patients.
So it's two sided. I think, uh.
And I think sometimes people come into the country and almost certainly glad they're sorry, but they're not thinking all the time of,
you know, physical explanation, might there be this person's anxiety disorder, you know, the right issues, et cetera.
And so I think that's why but we don't seem to be very successful in getting that integration.
Our enlistments book. Good book. Fantastic and lovely man.
Yes, he was our best man over. But just to go back to the general scene is a little more selective in any way.
The general adult psychiatry service has gone from there now as the numbers of inpatient psychiatric beds have been reduced nationally and of course,
locally, we've now own the all the all the psychiatric inpatient service general services are here at the Walter Reed Hospital.
But the but little more now. And of course, it's not the old hospital, it's the buildings over the road from the old hospital.
Now, the main thing there is it's a major forensic centre, but I think it's 12 consultants and forensic psychiatrist.
I had no know a huge friend because it was addiction at one time. Alcohol was.
Yes, yeah. You know, unfortunately, alcohol has alcohol problems have now moved out of health and community and charity money,
which I think is very wrong, very wrong, as you know, from working in General Hospital.
I mean, an awful lot of the problems you see there are alcohol related.
And of course, in the self harm population, it's a major, major issue.
And we've shown that people are dying from alcohol.
People are dying from alcohol. Problems relate who have been self harming a dying 30 over 30 years earlier than general population life expectancy.
And it's it's a huge issue. And yet we don't even have an alcohol service in the general hospital these days, which is so wrong.
Now, the developments here, I mean, do you think they've moved a bit towards the physical side?
In other words, if you can damage the brain, will that give you the answer?
I mean, in terms of research, yes, definitely. I mean, it's much more biological research.
I mean, Michael Gallagher's successor, Guy Goodwin, it was is primarily a biological psychiatrists.
So that was a huge influence in the in the shift. But I think the great thing about our department is it's retained.
The full span that I talked about earlier, Michael girl that was keen on mean,
I suppose you would be the most psycho social epidemiological end of psychiatry we've got.
You know, psychology is very strong. Um, uh, other social psychiatry, prisons research got quite a big programme on that.
But then a whole range of biological psychiatry.
And we're now fortunate in that dementia research here is really taking on a very big way.
And, um, so that's going to become a major, major focus.
Good way, Goodwin. He's been succeeded. Yes. He's still in the department, but he stepped down as head of the department.
John Kerry is now. What's his main interest? Well, I guess clinical trials is one of his main things.
And he set up a clinical trials, research of medicines all.
But he's got the whole range of the whole range medicines and psychological therapies and bipolar disorder,
which is a very, very major strength in the field in this department.
What have I asked you about that?
I should have, um, uh, I guess you off the island about when I thought of the medical school and I said I enjoyed it.
And I think one of the things that was so important then and afterwards for me was sport and, um, and that we you know, we're very strong on sport.
As you know, we had our first year and I came as a non rugby player to the medical school, unfortunately.
So I ended up loving rugby and started playing for them.
And I remember for the medical school side, I remember our first year unbeaten and playing quite strong teams in those days.
You were a three quarter. Yes. Yes, three quarter.
And people people like Tony Fisher and, of course, the psycho pharmacologist and his name still around, right?
Yes, I was recalled. Yes. And and of course, we had we had a that's time we had an all black trial,
is scrumhalf that he's got a lot of point where he was pretty formidable to the board.
So, I mean, we had a student who only came for a short while.
I was under 40, failed the exam and had to we went up to a London medical school, which is more enlightened to take him.
However, he played for Scotland on the wing and I remember his first game.
He's got three tries in the first 20 minutes. But I mean, the minute the rugby was fantastic, Oliver wouldn't play in that.
I know it's. And and then you played cricket at Cambridge, had you?
I think I play cricket all the way through. I've always loved cricket.
I started about age 11, played in Cambridge, didn't I didn't I wasn't up to university,
you know, first team standard, but, you know, a good college cricket standard.
And I came here and carried on playing and played until I was 63.
Very good for me if gave up and and with the students playing cricket.
Well, I don't know what I mean. This is one of the things in a sense, I was going to follow on.
I mean, as you know, rowing's become a huge strength in the medical school, but I mean, not cricket.
I don't know where they play. I mean, I was president of the cricket team and then it just sort of faded away.
And I was really disappointed. And I think they do play occasionally and we no longer have staff student games like we used to have and stuff.
I mean, rugby. I think it is pretty occasional.
I think they cut us like part because where we used to play at one time.
And I think it's interesting that I get the impression that what I would call the traditional sports,
rugby and cricket or football, I think still, you know, very soccer.
Yeah. But I think cricket and rugby and less people are doing other, more diverse things tennis, tennis, basketball, dancing.
I mean, it's you know, it's very popular.
And it was it's now a competitive sport. I mean, did you get into the Kendrick or.
I was into Hendrick, yes.